Interoperative Neuro‐Monitoring Needle Safety Flap – a new safety feature for IONM
SUNY Upstate Medical University is actively seeking partners interested in commercializing a new safety feature for interoperative neuromonitoring (IONM) needle electrodes which protects medical technicians from needle sticks during the procedure.
“IONM needle electrodes frequently cause needle stick injuries At Upstate Hospital, the most common type of injury associated by IONM needles are needle stick puncture wounds caused by the exposed tip of an IONM needle that has reemerged through a patient’s skin. When moving or shifting a patient, medical technicians inadvertently, or often unavoidably due to the large numbers of needles used, apply pressure to one or more of the shallowly placed IONM needle electrodes, forcing them back up through the skin surface and into their hand. Needle stick injuries can be very costly to an institution and dangerous to the person stuck. Current packaging for many IONM needle electrodes includes a cover over the needle to protect medical personnel before the needle’s use, and some IONM needle electrodes incorporate safety chambers into which the IONM needle electrode can be withdrawn to protect personnel after use, but until now no IONM needle electrode has incorporated a safety feature to protect personnel during a procedure, while the needle electrode is in place in a patient.”
Download the tech brief with contact info from: http://www.upstate.edu/techtransfer/pdf/1846_tech_brief.pdf
Read more about needle stick injuries: Needle Stick Injury in Intraoperative Neurophysiological Monitoring?
Book Review: Surgical Neurophysiology – A Reference Guide to Intra Operative Neurophysiological Monitoring – Second Edition Available NOW
Second Edition (2012) – Soft Cover – 410 Pages – ISBN-10: 147516498X ISBN-13: 978-1475164985
Faisal R. Jahangiri MD CNIM DABNM (Author)
*** Second Edition – Just Arrived ***
Brand New – Even better than before – The only comprehensive source available anywhere – more than 400 pages packed with useful information – Full Second Edition review.
Do you need to pass the CNIM or medical board exams? Are you looking for a practical reference guide and training manual on IONM? Are you performing physician oversight and need to know more about what is happening in the operating suite? If you replied “yes” to any of these questions, then this is the ideal text for you!
Practical information, along with 650 highly sought-after multiple choice sample test questions are conveniently sorted by modality and topic to get you organized. This second edition offers fully integrated material chosen to serve as an introduction to surgical neuromonitoring and as a complete study guide for exam preparation. Eliminating the need for multiple handouts on guidelines, sample tests and answer sheets, everything is held in this handy 6”x 9” comprehensive reference and study guide. Many illustrations, tables, photos and real case waveforms underscore precisely what you need to know about surgical neurophysiology and neuromonitoring.
Each of the twelve chapters is followed by a quiz to ensure successful immersion of the subject’s relevant definitions, principles, and applications. The author introduces the reader through “Basic Science & Instrumentation”, “Recording Concepts & Factors”, followed by “Anatomy & Physiology”. Amazingly simple illustrations are cleverly applied to successfully convey complex human anatomy and physiology. Subsequent chapters on modalities cover SSEP, EMG, TceMEP, Cranial Nerve Monitoring, BAEP, and EEG with all their sub-modalities (triggered EMG, TOF, ECoch, ECoG, DECS, etc.). These include analyses of advantages versus disadvantages of each modality, recording montages, parameter settings and peak latencies. Correlations between changes and surgical events are very well presented to develop the reader’s problem solving and decision making skills.
The chapter on “Disease & Pathology” is subdivided by anatomic structure, such as the cerebellum, cerebrum, brainstem, spinal cord, spine and cranial nerves to allow for a better understanding of modality requirements based on patient pathology and surgical procedure. Furthermore, vascular, muscular and peripheral nerve diseases are examined, along with all the relevant signs and syndromes encountered in pre-op patient exams and medical charts. “Anesthesia”, the final chapter, concludes this invaluable text.
Uniquely organized didactic and practical language separates this book. The author’s inspiration arose from his passion for teaching: “I felt the need for a comprehensive book about intraoperative neurophysiological monitoring when training technologists and neurophysiologists for certification examinations. This book is written in a new style focusing on all the basics and important topics that must be mastered in order to accurately perform intraoperative neurophysiological monitoring in high risk surgical procedures”, Dr. Faisal R. Jahangiri.
The Author: Faisal R. Jahangiri, MD, is currently Consultant Clinical Neurophysiologist in the Division of Neurology, Department of Medicine at King Abdulaziz Medical City in the Kingdom of Saudi Arabia. After completing medical school, general surgery and radiology residencies in Pakistan, he also attained a master’s degree in biomedical engineering at CWRU in Cleveland, Ohio. His research includes functional electrical stimulation (FES), EEG, and 3-D imaging for plastic reconstructive surgery. For the past decade, Dr. Jahangiri has been dedicated to IONM, having personally monitored in excess of 5,000 surgeries.
Dr. Jahangiri is an internationally recognized expert and a true ambassador of surgical neurophysiology whose passion for IONM culminates in multiple publications and high profile appearances. He also performs charitable IONM work in developing countries. The author’s unique approach to teaching IONM is exemplified in this expanded and improved second edition book.
Copyright © 2012 – All Rights Reserved – United Neurodiagnostic Professionals of America (UNPA)
Join the United Neurodiagnostic Professionals of America (UNPA) and become a member @ http://unpa.pro/Join
UNPA – Your Professional Networking, News, and Consulting Sources: A service brought to its members by the United Neurodiagnostic Professionals of America
$500 UNPA Scholarship 2012/2013
The United Neurodiagnostic Professionals of America is soliciting input from directors, instructors, or principals at accredited schools and/or programs in neurodiagnostic technology for the award of a $500 direct tuition/books assistance scholarship for the academic year 2012/2013.
Please reply with criteria suggestions in our discussion forum or contact the UNPA directly at info@unpa.pro.
United Neurodiagnostic Professionals of America – UNPA – Your Future in Neurodiagnostic Technology – http://unpa.pro/
Should I Talk to a Recruiter?
Should I Talk to a Recruiter?
As a highly in demand neurodiagnostic professional in intraoperative neuromonitoring, CNIM, neuro & orthopedic surgeon, or neurologist, it is very likely you may receive a phone call from a recruiter. Even if not interested in a career move at the time, it may still be beneficial to listen to the recruiter’s proposal. But, before divulging any information, ask questions! The more you know, the more you can ask.
Types of Recruiters
To work effectively with recruiters, you need to understand the different types of recruiters and how they can help you in your career development.
In-house recruiters are employed by hospitals, clinics and other healthcare facilities. They are involved in developing and implementing long-term staffing plans. Even with generous advertising budgets and other resources, in-house recruiters often utilize the services of agency recruiters when they encounter a difficult assignment, for example when trying to find a CNIM (Certification in Intraoperative Neurophysiological Monitoring) or a physician.
Agency Recruiters - there are two types of agency recruiters—retained and contingency. The former receives some kind of upfront fee for search efforts, with the balance of the fee due when the placement is finalized.
Clients call for retained recruiters when extensive and exclusive recruitment assistance is needed. This relationship between the retained recruiter and his client means the process is client-driven, not candidate-driven.
Contingency recruiters, just as retained recruiters, are loyal to clients who pay their fees. Yet much of their work is devoted to marketing professional job hunters. Given that time is money, contingency recruiters concentrate on working with the “most desirable candidates.” Career changers should keep in mind that “most desirable” does not necessarily mean “the best in terms of skill”. These are persons with impressive work experience, reasonable compensation expectations, and eagerness to take on a new position, possibly in another city.
How Recruiters Can Help Your Job Search
Either type of recruiter can assist you in your job search – if you ask the right questions. First, find out which type of recruiter you are dealing with. How the recruiter handles this question will provide insight as to whether this person is a straight shooter or a wordsmith. Next, try to find out how your contact information was obtained and be careful not to mention salary expectations too early in the process. When pressed to name a price, be wary.
Ask for the client’s name. Most recruiters will stall, claiming the client demands confidentiality. Simply say that you may already have contacts into the company and you wish to save them time and effort. Bear in mind, even if negotiations via a recruiter do not reach fruition, the client ( the potential employer ) is usually contractually prohibited from hiring you in the future. When dealing with large and consolidating companies, professionals can very possibly eliminate themselves from a respectable portion of the job market without even realizing it at the time.
Employee turnover rates, company culture, workload and company structure are all interesting topics of discussions between recruiter and professional. What happened to the person who is being replaced? Are your work and personal goals in alignment with the company’s culture? Is management stable or in transition? Who are the client’s stakeholders? In addition, recruiters can sometimes relay insight to delicate matters one might not feel comfortable discussing personally with a potential future employer, for example, “what sorts of hiring challenges is the client facing?”.
How You Can Help the Recruiter
Recruiters will appreciate open lines of communications while keeping them posted on your intentions, updated resume and references. A liaison between client and candidate, the recruiter values your feedback for current and future negotiations.
Copyright © 2012 – All Rights Reserved – United Neurodiagnostic Professionals of America (UNPA)
Join the United Neurodiagnostic Professionals of America (UNPA) and become a member of the $100k club @ http://unpa.pro/Join
UNPA – Your Professional Networking, News, and Consulting Sources: A service brought to its members by the United Neurodiagnostic Professionals of America
A snapshot of more than 100 advertised positions can be found at http://cnim-iom-jobs.com and http://unpa.pro/jobs. Additionally, a complete list of private neuromonitoring companies with website links can be viewed at http://unpa.pro/IOMservices (member service) revealing at least another 100 open positions. These listings do not include open positions placed through recruitment services. The average salary for IONM technologists is currently about $85,000 with a 30 hour work week, according to a 2011 direct survey by the Surgical Neurophysiology & Neuromonitoring Group. This translates to $100,000 +++ per year to include bonus and benefits if working a 40 hour week. The report is available for viewing at http://unpa.pro/IOMsalaries2011 (UNPA member service.)
Call for Action to the IONM community – Blue Cross of Idaho Policy Change – No Reimbursement without Physician Live Present in OR Suite – Tele-Monitoring Deemed Insufficient
Blue Cross of Idaho is implementing a policy in May 2012, where they are no longer going to reimburse for IOM unless a physician is live in the room. They will no longer recognize remote tele-monitoring.
This policy has many issues:
1) There are not enough physicians that are involved in monitoring to monitor live,
2) this will affect the livelihoods of an uncountable number of clinicians,
3) we cannot let this set a precedent for other insurance companies to follow.
To combat this proactively, a colleague has written a letter to the insurance company (emailed and sent certified). We have attached the letter. We feel it is important to get this out to our peers. We have attached the letter without heading and signature as well, this will allow our colleagues to put their header on it, sign it and send it. If you want to edit the letter that is fine also, but if we bombard this insurance company with letters and emails, we may be able to have the policy changed.
Additionally, we urge you to have the surgeons you work with writing letters as well, and as soon as you have that, send the letters the same way, so the IOM community can get their surgeons involved as well.
link to policy: https://www.bcidaho.com/providers/Policies/pap516.asp
Here is the info:
Blue Cross of Idaho
Attn Lance W Coleman, MD
3000 East Pine Avenue
Meridian, ID 83642
lcoleman@bcidaho.com
Download the sample letter here: IONM Just add header and signature Blue Cross of Idaho
Join the United Neurodiagnostic Professionals of America (UNPA) and become a member @ http://unpa.pro/Join
UNPA – Your Professional Networking, News, and Consulting Sources: A service brought to its members by the United Neurodiagnostic Professionals of America
CareFusion Neurodiagnostic Nicolet Division Sold! Natus Pays $58 Million Cash
SAN DIEGO Calif., April 23, 2012
CareFusion said this morning that it is selling its neurodiagnostics business to Natus Medical in a deal worth $58 Millions. CareFusion said its is selling off its Nicolet business to simplify and focus its operations in a strategy of controlling costs and realigning its businesses.
“The decision to divest the Nicolet business is in line with our strategy to simplify and focus our operations and prioritize our investments to profitably grow over the long term,” said Kieran Gallahue, chairman and CEO of CareFusion.
“The Nicolet acquisition will strengthen our existing neurology portfolio and provide us with new product categories,” said Jim Hawkins, CEO of Natus.
Natus Medical got some Wall Street love after picking up CareFusion’s Nicolet division for $58 million, a move that didn’t bode as well for CareFusion. Natus BABY shares trading 2.8% higher to $11.04 as of midday today. CFN shares where down 2% to $25.38.
Even more: http://www.massdevice.com/news/carefusion-hands-neurodiagnostics-unit-natus-medical-58m
Is the Cost of Neuromonitoring with Motor Evoked Potentials for Scoliosis Surgery Justified?
Cobb angle measurement of a scoliosis; concave side on the left; convex side on the right (Photo credit: Wikipedia)
“Intraoperative traction is associated wit frequent abnormalities in TcMep monitoring. The thoracic location of the major curve, mean Cobb angle of 86 degrees, and increased rigidity are risk factors for changes in TcMep monitoring with traction. The presence of any TcMep recordings at closure was associated with normal neurological function. Somatosensory evoked potentials should not be used as the sole means of scoliosis monitoring.”
The presence of any TcMep recordings at closure was associated with normal neurological function. Somatosensory evoked potentials alone is insufficient in accurately monitoring scoliosis correction.
There are more than 2 million annual surgeries in the U.S. alone where nerve damage is a major risk, representing an annual global revenue opportunity in excess of $500 million.
Kuklo, Timothy R. MD, JD (Washington University School of Medicine); Polly, David W. MD; Diab, Mohammad MD
Level of Evidence: II
Introduction: To analyze societal costs of routine neuromonitoring in deformity surgery versus the potential societal costs of spinal cord injury from an adverse surgical event in terms of malpractice settlements and lifetime patient care needs.
Methods: A national database of personal injury verdicts/awards (Westlaw) was searched to determine the average settlement after an adverse outcome following spinal surgery in the past 10 yrs, regardless of fault. Lifetime patient care needs were also determined, based on age at injury/life expectancy. 4,000 spinal deformity cases/yr in the US at a neural injury rate of .03% were assumed for analysis. The cost of neuromonitoring was determined to be $190/hr based on review of 2 separate hospital contract rates (mean $950/case). Search terms included spine surgery, scoliosis, paraplegia and neurologic injury yielded 110 potential cases, of which there were 43 defense verdicts, 22 cases determined to be n/a, and 27 injuries determined not to be related to surgery.
Results: The database yielded 18 cases of neural injury in spine surgery, of which 6 were deformity operations (ave. age 16.6 yrs) having an average verdict of $11.9 million (range $2.9–25.0 mil). The other 12 cases (ave $754,000 payout) did not involve spinal deformity. This also did not include an evaluation of settlements prior to trial, where payout of a typical structured settlement may be 1.5–5 times the final settlement. The estimated cost of neuromonitoring was $950/case X 4000, or $3.8 million/yr. Assuming a false negative rate of MEPs at ˜0.25% and an inability to monitor 10% of cases, potentially 3 cases/yr of paraplegia would be avoided with complete neuromonitoring (SSEP, MEP, EMG).
Conclusion: Assuming 12 cases of neurologic injury/yr (.03% of 4000 cases) not including other non‐paraplegic neurologic injuries and pre‐trial settlements, and with monitoring at $950/case ($3.8 mil/yr), a conservative estimate of societal savings would be over $30–40 mil/yr of direct costs ‐ hence insurance reimbursement of neuromonitoring services should be mandatory.
PAS Pleads Guilty to Healthcare Fraud Related to IOM Telemonitoring – Sentenced for Overbilling of Neuromonitoring Services
Metairie Doctor Sentenced for Receiving Materials Depicting the Sexual Exploitation of Minors and Health Care Fraud
Local Health Care Billing Company Also Sentenced for Committing Health Care Fraud
U.S. Attorney’s Office April 18, 2012
NEW ORLEANS—Dan Joachim, MD ., age 52, a resident of Metairie, Louisiana, was sentenced today to serve six years in prison before United States District Judge Martin LC. Feldman after previously pleading guilty as charged to receiving materials involving the sexual exploitation of minors and health care fraud, announced United States Attorney Jim Letten. Joachim was further ordered to repay $5,000 in restitution and sentenced to five years of supervised release after his term of imprisonment ends.
Physicians Analytical Services Inc. (PAS) a Maryland corporation that pleaded guilty to the same count of health care fraud, was sentenced to repay $500,000 in restitution and was also placed on one year of probation.
According to court documents, Joachim used multiple computers connected to the Internet to search for and download images of child pornography on a variety of websites. A forensic search of one such computer revealed that Joachim downloaded from the Internet and stored approximately 152 images and five videos of children as young as six months old being forced to engage in a variety of sexual activity with adults and animals. Joachim organized the images in folders he created on his computer.
Additionally, beginning in or about 2004, and continuing until in or about April 2010, Joachim worked as the Medical Director of a Maryland company called Intra-Op Monitoring Services Inc. (IOM).
IOM employed physicians to remotely monitor, through the use of an Internet connection, neurophysiological surgical procedures performed at hospital and surgical suites. An IOM-employed technician, meanwhile, was present in the operating suite to communicate with the telemonitoring physician. For the telemonitoring of a surgery to be legitimately billed, the in-suite technician had to be in contact with a physician, and the physician had to be available in real time to interpret the data via the web-based interface. Further, the monitoring physician had to be able, in real time, to convey the interpretation to the technician, who could relay the information to the surgeon.
In addition to his responsibilities as Medical Director, Joachim also was supposed to monitor surgeries. PAS was a wholly owned subsidiary of IOM and was responsible for billing-related matters.
PAS fraudulently billed various health care benefit programs for monitoring services that IOM-employed physicians did not provide and routinely overbilled for those monitoring services that were provided. In particular, PAS and other billing companies billed for telemonitoring services that did not occur. Often, the connection did not exist between the technician and the monitoring physician.
Other times, technical difficulties prevented the physician from monitoring most, or all, of the surgery. Additionally, PAS non-physicians would log onto the monitoring software using a physician’s log-in information, including the log-in information of Joachim, and pretend to be a physician and monitor surgeries in the place of physicians.
PAS also regularly upcoded the billing by representing that surgeries were being monitored for longer periods of time than the CPT codes permitted. For example, CPT codes provided for bills to be submitted for monitoring that took place between the time at which an electrophysiologic “baseline” was established and the ”closing” of the surgery. PAS, however, would routinely bill time spent prior to the establishment of a baseline, such as introducing the patient’s history to the monitoring physician or after the closing.
When insurers denied PAS’s requests for payment, the company routinely appealed those denials.
In doing so, PAS frequently claimed that the rejection of the claim was “inappropriate and unjust,” even though PAS was well aware that the claims submitted were false and fraudulent in that they represented that the surgeries had been monitored in real-time by physicians employed by IOM, when PAS well knew that the surgeries had not been so monitored.
A portion of this case was brought as part of Project Safe Childhood, a nationwide initiative to combat the growing epidemic of child sexual exploitation and abuse launched in May 2006 by the Department of Justice. Led by United States Attorneys’ Offices and the Criminal Division’s Child Exploitation and Obscenity Section (CEOS), Project Safe Childhood marshals federal, state, and local resources to better locate, apprehend, and prosecute individuals who sexually exploit children and to identify and rescue victims. For more information about Project Safe Childhood, please visit www.usdoj.gov/psc. For more information about Internet safety education, please visit www.usdoj.gov/psc and click on the tab “Resources.”
This case was investigated by special agents from the Federal Bureau of Investigation; the United States Department of Health and Human Services, Office of the Inspector General; and the United States Office of Personnel Management, Office of the Inspector General.
The prosecution of this case is being handled by Assistant United States Attorneys Patrice Harris Sullivan and Jordan Ginsberg.
Reported by: FBI
Limited copyright is granted to use and/or republish this article for any legitimate media purpose as long as you reference 7thSpace and any source mentioned in the story above. Please visit the original news source for more information: http://7thspace.com/headlines/410553/metairie_doctor_sentenced_for_receiving_materials_depicting_the_sexual_exploitation_of_minors_and_health_care_fraud.html
Published on: 2012-04-19
Keywords: Intraoperative Neurophysiological Monitoring; Neuromonitoring;
Sign this non-compete or you are FIRED! $1.2 million AWARD
Public policy exception to at-will employment. Blue states have no such exception; red states have some public policy exception. (Photo credit: Wikipedia)
A California jury awarded an employee who was fired for refusing to sign a noncompete agreement $1.2 million in damages for wrongful discharge. Whether employees have a right to refuse to sign unenforceable noncompete agreements is an emerging employment law issue. This issue certainly seems to be a point of contention when applied to any profession but has been prevalent in the field of neuromonitoring, in particular with private neuromonitoring companies.
This article considers whether a wrongful discharge remedy is available in such cases under the public policy exception to the employment-at-will doctrine. State court decisions addressing the question are conflicting. Some courts have allowed employers to discharge employees who refuse to sign a noncompete agreement even if the agreement is unreasonable. Other courts have recognized a claim for damages under the public policy exception. This article explores the issue from policy and managerial perspectives, critically analyzing the policy justifications advanced by the courts in those decisions, and comments on the liability risks to employers and the proper resolution of the issue.
Question: Do non-compte agreements further the provision of optimal patient care? Are such agreements in the public interest? You decide for yourself!
KEYWORDS: wrongful discharge; non-compete agreement; employment at will; public policy exception; neurodiagnostic professionals; CNIM; certification in intraoperative neurophysiological monitoring
Read and download the full article at: http://www.cob.sjsu.edu/malos_s/Non-compete%20agreements%20and%20public%20policy.pdf
Triggered EMG – Stimulation of coated pedicle screws in IONM – What is YOUR threshold value?
We all encounter instrumentation products from various manufacturers in our daily practice. Many different metals and coatings are used in an endless array of screws coming to the market almost daily. How do we determine the correct threshold? Are we carrying a list with values applicable to each product or are we guessing a safe value? Who is testing these products to determine its suitability for intraoperative neurophysiological monitoring? In product development, are the needs of IOM even considered? What are your thoughts?
Please consider the following research and presentation made available courtesy of Alpha Diagnostics, Santa Monica, CA
Please visit http://alphamonitoring.com/Research.html for more information.
PEDICLE SCREW ELECTRICAL RESISTANCE: HYDROXYAPATITE COATED VERSUS NON-COATED
Timothy T Davis, Ajay Vatave, James Patla, Johannes Bernbeck, Hyun W. Bae, Rick B. Delamarter
